Sentinel surveillance of HIV-1 transmitted drug resistance, acute infection and recent infection.

BackgroundHIV-1 acute infection, recent infection and transmitted drug resistance screening was integrated into voluntary HIV counseling and testing (VCT) services to enhance the existing surveillance program in San Francisco. This study describes newly-diagnosed HIV cases and characterizes correlates associated with infection.Methodology/principal findingsA consecutive sample of persons presenting for HIV VCT at the municipal sexually transmitted infections (STI) clinic from 2004 to 2006 (N = 9,868) were evaluated by standard enzyme-linked immunoassays (EIA). HIV antibody-positive specimens were characterized as recent infections using a less-sensitive EIA. HIV-RNA pooled testing was performed on HIV antibody-negative specimens to identify acute infections. HIV antibody-positive and acute infection specimens were evaluated for drug resistance by sequence analysis. Multivariable logistic regression was performed to evaluate associations. The 380 newly-diagnosed HIV cases included 29 acute infections, 128 recent infections, and 47 drug-resistant cases, with no significant increases or decreases in prevalence over the three years studied. HIV-1 transmitted drug resistance prevalence was 11.0% in 2004, 13.4% in 2005 and 14.9% in 2006 (p = 0.36). Resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI) was the most common pattern detected, present in 28 cases of resistance (59.6%). Among MSM, recent infection was associated with amphetamine use (AOR = 2.67; p<0.001), unprotected anal intercourse (AOR = 2.27; p<0.001), sex with a known HIV-infected partner (AOR = 1.64; p = 0.02), and history of gonorrhea (AOR = 1.62; p = 0.03).ConclusionsNew HIV diagnoses, recent infections, acute infections and transmitted drug resistance prevalence remained stable between 2004 and 2006. Resistance to NNRTI comprised more than half of the drug-resistant cases, a worrisome finding given its role as the backbone of first-line antiretroviral therapy in San Francisco as well as worldwide. The integration of HIV-1 drug resistance, recent infection, and acute infection testing should be considered for existing HIV/STI surveillance and prevention activities, particularly in an era of enhanced efforts for early diagnosis and treatment

Prevalence and correlates of cryptococcal antigen positivity among AIDS patients--United States, 1986-2012.

Cryptococcal meningitis (CM) is one of the leading opportunistic infections associated with human immunodeficiency virus (HIV) infection. The worldwide burden of CM among persons living with HIV/acquired immunodeficiency syndrome (AIDS) was estimated in 2009 to be 957,900 cases, with approximately 624,700 deaths annually. The high burden of CM globally comes despite the fact that cryptococcal antigen (CrAg) is detectable weeks before the onset of symptoms, allowing screening for cryptococcal infection and early treatment to prevent CM and CM-related mortality (2). However, few studies have been conducted in the United States to assess the prevalence of cryptococcal infection. To quantify the prevalence of undiagnosed cryptococcal infection in HIV-infected persons in the United States during 1986-2012, stored sera from 1,872 participants in the Multicenter AIDS Cohort Study and the Women's Interagency HIV Study with CD4 T-cell counts <100 cells/µL were screened for CrAg, using the CrAg Lateral Flow Assay (LFA) (Immy, Inc.). This report describes the results of that analysis, which indicated the overall prevalence of CrAg positivity in this population to be 2.9% (95% confidence interval [CI] = 2.2%-3.7%)

Microscopic calculation of the pinning energy of a vortex in the inner crust of a neutron star

The structure of a vortex in the inner crust of a pulsar is calculated microscopically in the Wigner-Seitz cell approximation, simulating the conditions of the inner crust of a cold, non-accreting neutron star, in which a lattice of nuclei coexists with a sea of superfluid neutrons. The calculation is based on the axially deformed Hartree-Fock-Bogolyubov framework, using effective interactions. The present work extends and improves previous studies in four ways: i) it allows for the axial deformation of protons induced by the large deformation of neutrons due to the appearance of vortices; ii) it includes the effect of Coulomb exchange; iii) considers the possible effects of the screening of the pairing interaction; and iv) it improves the numerical treatment. We also demonstrate that the binding energy of the nucleus-vortex system can be used as a proxy to the pinning energy of a vortex and discuss in which conditions this applies. From our results, we can estimate the mesoscopic pinning forces per unit length acting on vortices. We obtain values ranging between $10^{14}$ to $10^{16}$ dyn/cm, consistent with previous findings.Comment: Paper submitted for publicatio

Performance and operational characteristics of point-of-care tests for the diagnosis of urogenital gonococcal infections.

BACKGROUND: In 2012, there was an estimated 78 million new cases of gonorrhoea globally. Untreated infection may lead to reproductive and neonatal morbidity and facilitate HIV transmission. Diagnosis and treatment are a priority for control and prevention, yet use of point-of-care tests (POCTs) for Neisseria gonorrhoeae (NG) is limited. OBJECTIVES: To review the performance and operational characteristics of NG POCTs for diagnosis of urogenital gonorrhoea. METHODS: We compiled and synthesised findings from two separate systematic reviews which included evaluations published until August 2015. RESULTS: Six tests were included: five were immunochromatographic tests (ICTs) or optical immunoassay (OIAs) based on antigen detection; with 5-7 steps and results in 25-40 min, and one (GeneXpert CT/NG) was a 'near-patient test' based on nucleic acid amplification technique (NAAT); with three steps, electricity required, and results in 90 min. When compared with laboratory-based NAATs as the reference tests, sensitivities of ICT and OIA-based POCTs ranged from 12.5% to 70% when cervical/vaginal swabs were tested. Specificities ranged from 89% to 99.8%. The near-patient NAAT had sensitivities of >95% and specificities of >99.8% consistently across all specimen types (urine, cervical and vaginal swabs). CONCLUSIONS: Based on a limited number of evaluations, antigen detection POCTs for NG lacked sufficient sensitivity to be used for screening. A near-patient NAAT has acceptable performance, only involved a few steps, but needs electricity, a temperature-controlled environment and has a 90 min run time. To achieve wider scale up of NG POCTs, we need strong evidence of cost-effectiveness, which should inform guidelines and ultimately increase test development, demand and reduce costs

Surfactant-enhanced DNA accessibility to nuclease accelerates phenotypic β-lactam antibiotic susceptibility testing of Neisseria gonorrhoeae

Rapid antibiotic susceptibility testing (AST) for Neisseria gonorrhoeae (Ng) is critically needed to counter widespread antibiotic resistance. Detection of nucleic acids in genotypic AST can be rapid, but it has not been successful for β-lactams (the largest antibiotic class used to treat Ng). Rapid phenotypic AST for Ng is challenged by the pathogen’s slow doubling time and the lack of methods to quickly quantify the pathogen’s response to β-lactams. Here, we asked two questions: (1) Is it possible to use nucleic acid quantification to measure the β-lactam susceptibility phenotype of Ng very rapidly, using antibiotic-exposure times much shorter than the 1- to 2-h doubling time of Ng? (2) Would such short-term antibiotic exposures predict the antibiotic resistance profile of Ng measured by plate growth assays over multiple days? To answer these questions, we devised an innovative approach for performing a rapid phenotypic AST that measures DNA accessibility to exogenous nucleases after exposure to β-lactams (termed nuclease-accessibility AST [nuc-aAST]). We showed that DNA in antibiotic-susceptible cells has increased accessibility upon exposure to β-lactams and that a judiciously chosen surfactant permeabilized the outer membrane and enhanced this effect. We tested penicillin, cefixime, and ceftriaxone and found good agreement between the results of the nuc-aAST after 15–30 min of antibiotic exposure and the results of the gold-standard culture-based AST measured over days. These results provide a new pathway toward developing a critically needed phenotypic AST for Ng and additional global-health threats

Estimating nitrogen mineralizalion in a "cerrado" dark-red latosol by laboratory incubalion, and lhe effect of soil sample disturbance.

Foi avaliado, em laboratório, um método de incubação do solo para a determinação da mineralização do nitrogênio no campo e da perturbação das amostras de solo na mineralização de nitrogênio. Foram coletadas amostras de um Latossolo Vermelho-Escuro em quatro locais, com diferentes manejos, no Centro de Pesquisa Agropecuária dos Cerrados - CPAC/EMBRAPA - Planaltina, DF, e suas proximidades. Essas amostras foram incubadas a 35ºC e 0,25 bar de tensão de água. As taxas de mineralização variaram de 1,2 a 8,8kg de N/ha/semana, no período de incubação de doze semanas. Os dados sugerem que, para que haja um efeito da perturbação da amostra na mineralização de nitrogênio, há necessidade de um grau acentuado de desagregação do solo. A quantidade de nitrogênio mineralizada no período de incubação em laboratório apresentou baixa correlação com a mineralização do nitrogênio no campo.Four dark-red latosols (Haplustox) were sampled at or near the "Centro de Pesquisa Agropecuária dos Cerrados - CPAC" - (Cerrados Agricultural Research Center), in Planaltina, DF, Brazil. A laboratory soil incubation study, at 35 ºC and 0.25 bar water tension, was conducted to evaluate the effect of soil disturbance on N mineralization and to determine the suitability of an incubation procedure for estimating N mineralization in the field. Mineralization rates ranged from 1.2 to 8.8kg N ha-1 wk-1 over a twelve-week period. The data suggested that as long as there is some degree of soil aggregation, soil disturbance had no effect on N mineralization. The amount of N mineralized during the incubation period in the laboratory showed a low correlation with the N mineralization in the field